Scarcity (Jack Randall #3) (31 page)

“What’s with her B.P.?” he asked.

“It’s been low since we got her here. Her ejection fraction is crap. Low twenties at best.”

“Well I’d say she needs a new heart then. Where’s that surgeon guy? He stop at Starbucks or something?”

“Scrubbing in.”

“And the heart?”

They all just looked at one another.

“Really?” Dr. Jacobs asked, his sarcasm gone.

Kye walked to the small desk in the corner and picked up the phone. She dialed the number from memory.

“ETA on the heart . . . okay . . . we’re ready here . . . all right.” She hung up and faced the room. “They’re leaving the airport now.”

“Thank God. Much easier with a new heart.”

The team relaxed again with the return of Dr. Jacob’s sarcasm. He was a favorite as he always kept the mood light.

“When we get done, can one of you kids fix my iPad for me?”

Any answer to his question was cut off by Dr. Fong entering the room.

“Good evening everyone. Are we ready?”

“We’re ready here, the heart’s about thirty minutes away.”

“I’d like to see it before we start. It’s coming from Mexico and I really don’t have a whole lot of information on it yet. They faxed the chart on the donor, but all I can really read are the labs and stuff, everything else was in Spanish.”

“Isn’t there an app for that?” Tony teased.

“Actually there is, but it gets lost in the medical jargon. How about you invent one for us? Make yourself a few million.”

“I may have some time this weekend. I’ll see what I can do.”

Their conversation was cut short by the alarms of the monitor. They all swiveled their heads in unison to stare at the overhead screens.

“She’s throwing PVCs,” Dr. Jacobs announced.

Dr. Fong stepped forward to see the monitor better. The tracing on the screen that represented each heartbeat was wider than normal due to her injury. He tried to ignore the increasing premature ventricular contractions and pick out the underlying rhythm.

“She’s getting wider,” he solemnly observed. “Stephanie?”

“Yeah?”

“You better get your stool. We have access yet?”

“Yes,” said Jacobs from behind the drape.

Dr. Fong watched a moment longer before turning to find Kye holding his gown and gloves.

“Let’s move, she’s gonna crash!”

As if on cue, the girl’s heart rhythm changed from an irregular mess of lines to a rapidly oscillating pattern.

“V-tach. Get on the chest.”

Dr. Fong watched as Stephanie placed her hands on the girl’s chest and began pumping. Dr. Jacobs scrambled to open the crash cart. He quickly ripped open a tan box and extracted the pre-filled syringe. It was injected quickly into the girl’s central line.

“Epi’s in.”

Kye tore a form from her pile and wrote down the time.

“What’s happening?” Doctor Fong asked the room as he was still completing the gown and glove routine and spinning in a circle to aid Tony who was assisting him with getting it tied. He stopped the spin and his eyes immediately returned to the screen over his head. All he saw was the steady spikes created by Stephanie’s chest compressions. She stopped for a moment and gazed at the screen, also. A squiggly line with no organization traveled across the screen.

“No pulse.”

“That’s V-fib, let’s shock her.”

Kye produced the monitor out of thin air and slammed it down on the table next to the ventilator before firing up the screen. After changing some settings, the whine of the capacitor charging urged those at the table to place the pads as soon as possible.

“Everybody clear?” She scanned the girl’s body, looking for any contact with the team members. Jacobs injected another drug before quickly dropping the IV line.

“Lidocaine’s in.”

Not waiting for them to answer, Kye pressed the button. Tessa’s body responded with a shiver that threatened to send her off the table. The line on the screen flattened out for a moment only to quickly return to its chaotic origin.

“Nothing,” Stephanie voiced before returning her hands to the girl’s chest and taking up the steady rhythm she’d had before.

“Another epi,” Fong ordered. He watched as Jacobs pushed the drug before turning to address his circulating nurse.

“Where’s that heart at again?”

“On its way, maybe twenty minutes.”

Dr. Fong absorbed the information before turning to his perfusionist.

“Are we ready, Mike?”

“I’m set up for the transplant. What are you thinking?”

Fong was silent as he weighed his options. All of them sucked at the moment. He watched the CPR being performed on the screen. The team sat frozen except for Stephanie who was already sweating from the effort, awaiting his decision. The rest of them were scrubbed in and unable to help her without contaminating themselves.

“That heart isn’t coming back, we’re crashing on.”

“Bypass now?”

“Right now! Mike?”

Mike was scrambling to comply. “I’ll be ready by the time you get in!”

“Let’s go.”

Dr. Fong picked up a bottle of Betadine and Stephanie barely got her hands clear before he emptied it onto the girl’s chest.

The surgeon’s hands probed for landmarks before one of them shouted out, “10-blade!”

•      •      •

Luis counted the stack of bills again as he arranged them into piles that would fit in the large bags he had obtained. The father had made several phone calls and repeatedly argued with bank presidents to obtain the growing mountain of cash. Couriers from three different banks had come to the house in the last couple of hours, and there were still two more on their way. Luis suppressed his grin as the pile on the table grew. The wife had retreated to the living room where she continued to sob. Her husband had finally left her to her grief, and he now impatiently paced the floor. He alternated between watching Luis count the money and eyeballing the driveway for the next armored car.

Luis heard another vehicle pull up outside, but chose to ignore it so as not to ruin his count. He began stuffing another pile into the heavy canvas bag, making room for more on the large table. He heard the footsteps approach, but didn’t bother to look up.

“Just place it here on the table,” he ordered.

“Packing for a trip?”

Luis stopped. It was a familiar voice. He looked up to see the head of the Mexican AFI standing in the doorway. Another agent appeared next to him, followed by a third in the other doorway. Luis suddenly realized he could hear several engines running outside. More agents moved past the windows, surrounding the house.

“I don’t understand!” the father shouted from down the hall as he was being led away by other agents.

“He doesn’t understand, Hector. Or should I call you Luis? I can’t say I do, either. Perhaps you wouldn’t mind explaining to me what one of my agents is doing playing the role of a K and R negotiator?”

“Just a little side job, boss, nothing more.”

The man walked forward and examined the pile of bills on the table. He picked one up and fingered it before tossing it back on the pile. He nodded to himself as if considering the explanation. Hector/Luis began to sweat.

“Side job. Is that what you call it?”

“Yes. Their daughter has been kidnapped. I am trying to free her.”

“I see. This is the ransom then, or a first payment?”

“A . . . a first payment.”

The man just nodded as he casually reached into his pocket and pulled out the bag of fingers and dropped them on the table in front of Luis.

“And this? Is this your work?”

Luis froze in horror as his brain searched for an explanation to offer. It was cut off by his boss suddenly slamming a fist into his gut. He doubled over and fell to the tile. The man’s boots began kicking him and he hid his head in his arms to protect himself.

“You fucking animal! You do this on my watch! I will see you dead! I’ll throw you in prison with the rest of your kind and they will feed off you!” The kicks continued without mercy while the other agents watched.

The man’s rage eventually subsided and he glared down at his subordinate, both of them breathing heavily.

“Take this garbage away before I kill him myself!”

The others moved in and yanked Luis from the floor only to slam him face down on the table. As he was pinned down and cuffed, the blood flowed freely from his lip and nose and he bled onto the stacked bills he had so gleefully counted a moment ago. He was quickly dragged to his feet and shoved out the back door. His boss followed him as he was led past his coworkers, most of whom glared at him with contempt while some just turned away. Out in the driveway he was led past several police cars. One of them had an occupant he recognized.

Cuffed and bloody much like he was, the detective gazed back at him through the thick glass.

The head of the AFI watched from the doorway before turning and heading back inside to talk to the parents.

He had bad news for them.

•      •      •

Manuel tapped his credit card loudly on the counter in an effort to speed the work of the rental car employee. Seeing the looks of the passing travelers, he reined himself in. He didn’t want to call attention to himself, but he also needed every minute. He had thought long and hard about his options on the plane ride back to Florida, and had come to the conclusion that he was trapped in the situation. He had never dreamed it would come to this. Jimmy was like a father. He had surely done more for him than his real father had ever done. But he had no choice, it was either do as Rico had ordered, or be in the same position as Jimmy was now. Manuel was a hunter. Being the prey was not something he was prepared for or ever wanted to be.

The card tapping had drawn the gaze of the man’s supervisor and Manuel quickly covered by stopping and offering a charming smile to the woman. She had been checking him out since his arrival.

“Sorry, just running late. Damn airlines are never on time at night.”

“True. I’m afraid there’s not much we can do about that.”

Manuel waved the apology away. “Not your fault. I’m just ready to be in my own house for a change.”

“I can understand that. How we doing, Nick?”

Nick responded by hitting a last keystroke and reaching for the printout emerging from the printer.

“We’re done. If you could just sign here and here, sir?”

Manuel scribbled an illegible signature at the indicated spaces before tearing his own receipt away and returning the paper. Nick smiled as his customer was obviously an experienced traveler. He slid the keys across the counter and the man quickly palmed them before stooping to collect his small bag and heading for the door.

“It’s the white Mustang in slot four,” Nick called after him.

“Thank you,” Manuel acknowledged as he charged through the door.

Nick shared an amused look with his supervisor as they both watched him sprint across the lot through the windows.

“She must be really something.”

“Lucky girl,” she answered.

She got a snort and a laugh for a reply before they both went back to their computer screens.

Organ trafficking was long considered a myth.
But now mounting evidence suggests it is
a real and growing problem, even in America.
Jan 9, 2009—Newsweek

—TWENTY-FOUR—

“C
lear!” Dr. Fong ordered and Stephanie removed her hands from over the incision he had just made. They were alternating between chest compressions and opening the chest as best they could. Dr. Fong quickly filled the space with the sternal saw and crammed its hooked point under the girl’s ribcage.

The saw cut through the girl’s sternum with some steady pressure, with Dr. Fong adding an extra push to get through the sternal notch at the top. He quickly passed the saw into Tony’s waiting hands while Stephanie accepted the rib spreader and inserted it into the gap. Dr. Fong silently cursed the device’s lack of speed as he cranked the girl’s chest open. A Bovie scalpel found its way into his hand as if by magic and smoke rose from the site as he set about opening the pericardium while Stephanie gave the spreader another crank. Instead of the beating heart they were used to finding, the chest cavity was shockingly still.

“We ready, Mike?”

“Close.”

“Where we at on the heprin?”

“One and a half minutes!”

Mike adjusted a clamp before double checking all of his connections.

“We’re ready!”

As soon as he had the smallest of openings, Dr. Fong stuck a hand in to begin squeezing the heart. As he was pumping with one hand he carefully expanded the opening with the other. Stephanie grabbed the first cannula from the rack clamped to the drape over the girl’s chest.

“I’m ready here.”

“We’re just gonna stab and go. Okay?”

“Okay.” She nodded and a bead of sweat crawled down her forehead. She ignored it and tried to slow her breathing as it was fogging her goggles.

Tony was scrambling to stay ahead of the doctor and anticipate his needs, but this was something he wasn’t used to. Nevertheless, he had the scalpel ready when the doctor’s free hand shot out for it.

Dr. Fong stopped squeezing the heart and quickly located the aorta. Accepting the scalpel from Tony, he expertly flipped it in his hand and made a stabbing incision in the large vessel. Blood poured from the wound and clouded his view, but Stephanie was ready with the suction. She handed him the cannula and he deftly inserted it into the wound.